Patient Test Information

Ceruloplasmin

Formal name:

Ceruloplasmin, serum

Related tests:

Copper

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Why Get Tested?

To measure the amount of ceruloplasmin in the blood; to help diagnose Wilson disease; sometimes to help identify conditions associated with copper deficiencies

When to Get Tested?

When you have jaundice, fatigue, abdominal pain, behavioral changes, tremors, or other symptoms that a health practitioner thinks may be due to Wilson disease or, rarely, to copper deficiency; at intervals when monitoring is recommended

Sample Required?

A blood sample drawn from a vein in your arm

Test Preparation Needed?

None

How is it used?

Ceruloplasmin testing is used primarily, along with blood and/or urine copper tests, to help diagnose Wilson disease, a rare inherited disorder associated with excess storage of copper in the liver, brain, and other organs, and with decreased levels of ceruloplasmin.

Copper is an essential mineral that performs vital roles in the body. About 95% of the copper in the blood is bound to ceruloplasmin. Only a small amount of copper is normally present in the blood in a free (unbound) state. For more information, read the "What is being tested?" section.

Rarely, a ceruloplasmin test may be ordered with a copper test to help diagnose abnormalities in copper metabolism, copper deficiencies, or the rare inherited disorder Menkes kinky hair syndrome.

When is it ordered?

A ceruloplasmin test may be ordered alone or along with blood and 24-hour urine copper tests when someone has signs and symptoms that a health practitioner suspects may be due to Wilson disease, such as:

  • Anemia
  • Nausea, abdominal pain
  • jaundice
  • Fatigue
  • Behavioral changes
  • Tremors
  • Difficulty walking and/or swallowing
  • Dystonia

Rarely, ceruloplasmin may also be ordered along with copper tests when a health practitioner suspects that someone has a copper deficiency. Ceruloplasmin may be ordered periodically to monitor those with excess or deficient copper and periodically to evaluate the effectiveness of treatment.

What does the test result mean?

Ceruloplasmin levels are not diagnostic of a specific condition and are usually evaluated along with copper tests.

Test results may include:

Test Wilson disease Copper Toxicity Menkes Disease (Kinky Hair Syndrome) Copper Deficiency
Copper, blood Low but may be normal High Low Low
Copper, serum free High High Low Low
Ceruloplasmin Low but may be normal High Low Low
Copper, urine Very high High Low Low
Copper, liver/hepatic* Positive but, depending on the site sampled, may be negative High or normal Low Low

*Excess copper in the liver is often unevenly distributed and may not be detected in a sample.

  • Decreased ceruloplasmin and blood copper concentrations and increased urine copper levels may indicate Wilson disease.
  • About 5% of people with Wilson disease who have neurological symptoms will have normal ceruloplasmin levels as will up to 40% of those with hepatic symptoms, especially if they are acutely ill.
  • If ceruloplasmin and urine and/or blood copper concentrations are low, then the person tested may have a copper deficiency.
  • Anything that interferes with the supply of copper or with the body's ability to metabolize copper has the potential to affect blood ceruloplasmin and copper concentrations.

Is there anything else I should know?

Ceruloplasmin may be increased in a variety of circumstances where the test is not used as a clinical tool. However, these conditions can affect interpretation of the test and the ability to recognize Wilson disease or copper deficiency. These may include the following:

  • Ceruloplasmin is an acute phase reactant. It is frequently elevated when someone has inflammation, severe infection, tissue damage, and may be increased with some cancers.
  • It may be increased during pregnancy and with the use of estrogen, oral contraceptives, and medications such as carbamazepine, phenobarbital, and valproic acid.

What is being tested?

Ceruloplasmin is a copper-containing enzyme that plays a role in the body's iron metabolism. This test measures the amount of ceruloplasmin in the blood.

Copper is an essential mineral that plays a role in the regulation of iron metabolism, formation of connective tissue, energy production at the cellular level, and the function of the nervous system. It is absorbed from food and liquids by the intestines and then transported to the liver, where it is stored or used to produce a variety of enzymes.

The liver binds copper to a protein to produce ceruloplasmin and then releases it into the bloodstream. About 95% of the copper in the blood is bound to ceruloplasmin. Because of this, the ceruloplasmin test can be used along with one or more copper tests to help diagnose Wilson disease, an inherited disorder that can lead to excess storage of copper in the liver, brain, and other organs.

How is the sample collected for testing?

A blood sample is obtained by inserting a needle into a vein in the arm.

NOTE: If undergoing medical tests makes you or someone you care for anxious, embarrassed, or even difficult to manage, you might consider reading one or more of the following articles: Coping with Test Pain, Discomfort, and Anxiety, Tips on Blood Testing, Tips to Help Children through Their Medical Tests, and Tips to Help the Elderly through Their Medical Tests.

Another article, Follow That Sample, provides a glimpse at the collection and processing of a blood sample and throat culture.

Is any test preparation needed to ensure the quality of the sample?

No test preparation is needed.

  1. Should everyone have a ceruloplasmin test?

    Ceruloplasmin is not a routine test. Unless your healthcare provider suspects that you have Wilson disease or a problem with your copper metabolism, it is unlikely that you will ever have this test performed.

  2. Can I have the ceruloplasmin test done in my healthcare provider's office?

    No. It is a specialized test that is not offered by every laboratory. Your blood sample may need to be sent to a reference laboratory.

  3. Do I need to have a liver biopsy?

    If Wilson disease is strongly suspected based upon blood, urine, and imaging test results, a liver biopsy may be performed to evaluate hepatic copper content and the extent of liver damage.